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New cholesterol guidelines offer a more personalized approach

November 10, 2018 - 12:12 pm
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By Jessica Ravitz, CNN

(CNN) -- New cholesterol guidelines recommend a more personalized approach in risk assessments, a returned focus on LDL target levels and new drug options for those at highest risk for cardiovascular disease. The guidelines were announced Saturday during the American Heart Association's annual scientific conference.

The recommendations, set out by the American Heart Association and the American College of Cardiology, also discussed the value of using coronary artery calcium scores for some patients and expanded the age range for treatment.

"High cholesterol treatment is not one size fits all, and this guideline strongly establishes the importance of personalized care," Dr. Michael Valentine, president of the American College of Cardiology, said in a written statement.

"Over the past five years, we've learned even more about new treatment options and which patients may benefit from them. By providing a treatment roadmap for clinicians, we are giving them the tools to help their patients understand and manage their risk and live longer, healthier lives."

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The new recommendations address many of the concerns raised when the guidelines were last updated five years ago.

Those 2013 guidelines were troublesome for a number of reasons, explained Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic: The previous guidelines used a risk calculator that left out crucial components such as family history; they didn't address the issue of people older than 75 or younger than 40; they overhyped the risks many patients faced; lowered the threshold needed to warrant statin drug therapy; and did away with the use of LDL (bad) cholesterol target levels, which helped patients set meaningful goals.

People with LDL levels of 100 or lower, "tend to have lower rates of heart disease and stroke, supporting a 'lower is better' philosophy," according to a statement from the medical organizations about the new guidelines.

"This is a step forward," Nissen said. "It took five years to fix the problems with the last set of guidelines, but I'm glad they've been addressed."

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Nissen, who was highly critical of the 2013 guidelines, offered just one criticism of the new ones: the recommendation that coronary artery calcium scores be used to help determine the need for cholesterol-lowering treatments in patients for whom the need isn't clear. This score shows plaque buildup in arteries and is determined through a CT scan.

"You're radiating somebody in order to decide whether to use a drug that costs as little as $3 a month, and you're spending a lot of money -- $800 to $1,000 [for the CT scan] -- to do it," he said. "I just don't think it's prudent."

But other than that issue, Nissen is pleased. "The big picture is this is a reasonable set of guidelines," he said.

Heart disease is the leading cause of death in the US, according to the US Centers for Disease Control and Prevention. Cardiovascular disease, which includes conditions that cause heart attacks and strokes, account for more than 836,000 deaths a year, according to the American Heart Association and the American Stroke Association.

"Having high cholesterol at any age increases that risk significantly," Dr. Ivor Benjamin, president of the American Heart Association, said in a written statement. "That's why it's so important that even at a young age, people follow a heart-healthy lifestyle and understand and maintain healthy cholesterol levels."

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